Trade References

Reference 1

Reference 2

Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Reference 3

Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Reference 4

Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Reference information furnished by

Terms

Buyer/Applicant authorizes Metraflex Company and its representatives to inquire into Buyer’s/Applicant’s credit history and to contact Buyer’s/Applicant’s references given, in addition to any other person, corporation or other entity, for the purpose of determining the credit worthiness of the Buyer/Applicant.

As a requirement of extending the credit privilege to Buyer/Applicant and in consideration for any extension of credit, Buyer/Applicant agrees to abide and be bound by Metraflex’s “Terms & Condition of Sale” as shown at www.metraflex.com/terms and incorporated herein by reference, applicable to each and every transaction between Metraflex and the Buyer/Applicant regarding the Sales of Metraflex products. Buyer/Applicant further agrees to execute from time to time any and all documentation reasonable requested by Metraflex to satisfy Metraflex that its “Terms and Condition of Sale” shall be controlling.

All invoices are DUE IN NET 30 DAYS. Invoices NOT paid within 30 days are PAST DUE.

All invoices, which are not paid in NET 30 DAYS are subject to a Service Charge of 1-1/2% interest PER MONTH, commencing with the 31st day and continuing until the funds are received by Metraflex.

Should the customer be a corporation, the undersigned agrees that by execution hereof, he/she or they are authorized to commit the customer for payment of all indebtedness or liabilities incurred pursuant to this agreement, demand for payment and notice of indebtedness and default are expressly waived.

Should it become necessary for Metraflex to retain an attorney to make demand upon or collect any past due invoices or statements, the customer agrees to pay all recording fees and court cost, incurring by Metraflex through all appeals, and bankruptcy proceedings, if any. Metraflex and the customer agree Metraflex shall choose the venue of any action brought to collect past due invoices or statements, or enforce any provision of this agreement.

Name*

Indicate exceptions here

If your office is a branch or subsidiary, please list theParent Company or Home Office.

Parent company

Phone

All orders during this time will be handled on COD,Check in Advance, or Credit Card basis.